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Kalidindi S, Gandhi S. Prevalence of Sinus Mucosal Abnormalities on CT of the Head Performed for Headache When Compared With Those Performed for Other Indications. Cureus 2024; 16:e56608. [PMID: 38646207 PMCID: PMC11031627 DOI: 10.7759/cureus.56608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
Background There is a high prevalence of mucosal abnormalities of paranasal sinuses on CT Head scans performed for all indications. The purpose of this study is to see whether or not such abnormalities are more common in scans performed on patients presenting with headaches when compared with those without headaches. Methods Images of CT scans of the brain of 100 consecutive patients from each of the two study groups (a total of 200 scans) were retrospectively reviewed for the presence of sinus mucosal abnormalities and their Lund-Mackay (LM) scores were calculated. A corrected LM score was also calculated using a correction factor for non-visualized sinuses in some scans and osteomeatal complexes in all scans. Radiological reports for these scans were also reviewed to note whether or not they contained any comments on the sinuses. All the reviewed scans were performed between January 1, 2021 and January 22, 2021. Results In the headache group, 17 patients had an LM score above 4 (which was used as the main cut-off point for this study). In the non-headache group, 16 patients had a score greater than 4. The mean LM score in the headache group was 1.24 and in the non-headache group was 1.4. There has been no significant difference in the comparison when corrected LM scores were used. In the headache group, 22 radiology reports contained comments on the sinuses compared to 11 reports in the non-headache group. Conclusion Results of this study indicate that there is no significant difference in the prevalence of clinically important sinus mucosal abnormalities in patients who had a brain CT for headache when compared with other indications. It was found that radiologists tend to comment on the sinuses more often when the indication was headache. It may be reasonable for radiologists to consider reviewing this practice. This might reduce unnecessary referrals to ENT and, more importantly, avoid missing other reasons for headaches.
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Affiliation(s)
| | - Sanjay Gandhi
- Radiology, North Bristol Hospitals NHS Trust, Bristol, GBR
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Sheikh S, Ho ML, Eisner M, Gushue C, Paul G, Holtzlander M, Johnson T, McCoy KS, Lind M. Elexacaftor-Tezacaftor-Ivacaftor Therapy for Chronic Sinus Disease in Cystic Fibrosis. JAMA Otolaryngol Head Neck Surg 2023; 149:1075-1082. [PMID: 37676668 PMCID: PMC10485743 DOI: 10.1001/jamaoto.2023.2701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/10/2023] [Indexed: 09/08/2023]
Abstract
Importance Cystic fibrosis (CF) is a multiorgan genetic disease with progressive upper and lower airway involvement. The effects of CF transmembrane conductance regulator (CFTR) modifier therapies on CF-related upper airway disease, specifically chronic rhinosinusitis (CRS), are not characterized. Objective To determine the outcome of elexacaftor-tezacaftor-ivacaftor (ETI) on CRS as measured by changes in sinus computed tomography (CT) metrics and on clinical parameters in individuals with CF. Design, Setting, and Participants This prospective longitudinal cohort study was conducted at the CF center of a tertiary care hospital between October 1, 2019, and July 31, 2021. A total of 64 participants with CF were included in the analysis. Intervention Sinus CT was obtained within 1 month of initiation of ETI therapy (baseline), and within 1 month of 1 year of ETI therapy. Images were independently analyzed by pulmonology, radiology, and otolaryngology physicians, using the Lund-Mackay and Sheikh-Lind scoring systems. Percent predicted forced expiratory volume in 1 second (ppFEV1), body mass index (BMI), and microbiologic data collected at initiation of ETI therapy and 3-month intervals for 1 year were also measured. Main Outcomes and Measures The study hypothesis was that ETI therapy will improve CRS as measured by changes in sinus CT at initiation and 1 year after ETI therapy and clinical parameters in individuals with CF. Results Among the 64 participants (39 [60.9%] female; median age, 18.5 [IQR, 16.0-28.5] years; 64 [100%] White), improvement in CRS was noted by improvements in sinus CT scans using both sinus CT scoring systems after 1 year of ETI therapy. The reduction in the median total score using the Lund-Mackay sinus CT scoring system (from 5.8 [IQR, 5.0-7.0] to 3.3 [IQR, 2.6-4.2]) and the Sheikh-Lind scoring system (from 3.8 [IQR, 3.0-5.0] to 2.2 [IQR, 2.0-2.5]) was noted. Increases in ppFEV1 and BMI were also observed by 3 months of ETI therapy with persistent improvement through 1 year of treatment. Similarly, after 1 year of ETI therapy, participants with CF had reductions in positivity for Pseudomonas aeruginosa and Staphylococcus aureus in oropharyngeal cultures. Conclusion and Relevance This cohort study found that use of ETI therapy was associated with improved CRS outcomes in participants with CF as quantified by improved sinus CT scans measured by 2 radiographic scoring systems and was also associated with improved clinical outcomes. Despite improvement in CT scan scores, most people with CF continue to have scores that indicate severe sinus disease.
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Affiliation(s)
- Shahid Sheikh
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Mai-Lan Ho
- Nationwide Children’s Hospital, Columbus, Ohio
- Department of Radiology, The Ohio State University College of Medicine, Columbus
| | - Mariah Eisner
- Nationwide Children’s Hospital, Columbus, Ohio
- Biostatistics Resource, Nationwide Children’s Hospital, Columbus, Ohio
| | - Courtney Gushue
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Grace Paul
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Melissa Holtzlander
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Terri Johnson
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Karen S. McCoy
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, Ohio
- Nationwide Children’s Hospital, Columbus, Ohio
| | - Meredith Lind
- Nationwide Children’s Hospital, Columbus, Ohio
- Department of Otolaryngology, The Ohio State University College of Medicine, Columbus
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Fischborn AR, Andreis JD, Wambier LM, Pedroso CM, Claudino M, Franco GCN. Performance of panoramic radiography compared with computed tomography in the evaluation of pathological changes in the maxillary sinuses: a systematic review and meta-analysis. Dentomaxillofac Radiol 2023; 52:20230067. [PMID: 37192021 PMCID: PMC10304843 DOI: 10.1259/dmfr.20230067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/20/2023] [Accepted: 04/19/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVE A systematic review was performed to evaluate the performance of panoramic radiography (PR) vs CT or cone beam CT (CBCT) in the diagnosis of pathological maxillary sinuses. METHODS This review was registered in the PROSPERO database under the number CRD42020211766. Observational studies that compared PR with CT/CBCT were used to evaluate pathological changes in the maxillary sinuses. A complete search of seven primary databases and gray literature was carried out. The risk of bias was assessed according to the Newcastle-Ottawa tool, and the GRADE tool was used to assess the quality of evidence. A binary meta-analysis was performed to assess the effectiveness of evaluating pathological alterations in the maxillary sinuses in PR and CT/CBCT. RESULTS Seven studies were included in our study, out of which four were included in a quantitative analysis. All studies were classified as low risk of bias. Five studies compared PR with CBCT and two studies compared PR to CT. The most common pathological alteration in maxillary sinuses reported was mucosal thickening. CT/CBCT was seen to be the most effective method for assessing pathological changes in the maxillary sinus when compared to PR (RR = 0.19, 95% confidence interval [CI] = 0.05 to 0.70, p = 0.01). CONCLUSION CT/CBCT are the most appropriate imaging methods to evaluate pathological changes in the maxillary sinuses, while PR is still limited in the evaluation of these changes being considered only for initial diagnosis.
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Affiliation(s)
| | | | - Leticia Maíra Wambier
- School of Health and Biological Sciences, Universidade Positivo, Street Prof. Pedro Viriato Parigot de Souza, Curitiba, Brazil
| | - Caique Mariano Pedroso
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Campinas, Brazil
| | - Marcela Claudino
- Dentistry Department, State University of Ponta Grossa (UEPG), Ponta Grossa, Parana, Brazil
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Walters ZA, Phillips KM, Previtera MJ, Gray ST, Sedaghat AR. Minimal Radiographic Mucosal Thickness or Opacification Criterion for Sinus-Specific Endoscopic Sinus Surgery for Chronic Rhinosinusitis. Otolaryngol Head Neck Surg 2023. [PMID: 36807128 DOI: 10.1002/ohn.297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Primary chronic rhinosinusitis (CRS) is typically a diffuse process and the extent of endoscopic sinus surgery (ESS) performed for medically recalcitrant CRS is impacted by many factors. However, some third-party payors have implemented policies to authorize coverage for ESS in a sinus-by-sinus manner based on a minimal measurement of millimeters of mucosal thickening or sinus opacification in the corresponding sinus that is being surgically addressed. Our objective was to determine whether such policies are based on scientific evidence that in patients with medically recalcitrant CRS, a minimum measurement of mucosal thickening or sinus opacification is a predictor of CRS in that sinus or improved outcomes after ESS on a sinus-by-sinus basis. DATA SOURCES Medline, Embase, Scopus, and Web of Science databases, from inception through May 2022. REVIEW METHODS A systematic review was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. RESULTS We identified 6070 abstracts which were screened and from which 112 studies ultimately underwent a full-text review. From these studies, we found that none investigated (or provided evidence of) whether any minimal degree of radiographic mucosal thickening or sinus opacification predicted CRS or better outcomes after ESS in a sinus-specific manner. CONCLUSION We were unable to find evidence supporting a minimum millimeter measurement of mucosal thickening or sinus opacification as predictors of CRS or better post-ESS outcomes in a sinus-specific manner in patients with medically recalcitrant CRS. The extent of ESS for CRS should be determined through personalized medical decision-making that considers all patient-specific factors.
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Affiliation(s)
- Zoe A Walters
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katie M Phillips
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Melissa J Previtera
- Health Sciences Library, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stacey T Gray
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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5
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Beswick DM, Humphries SM, Miller JE, Balkissoon CD, Khatiwada A, Vladar EK, Ramakrishnan VR, Lynch DA, Taylor‐Cousar JL. Objective and patient-based measures of chronic rhinosinusitis in people with cystic fibrosis treated with highly effective modulator therapy. Int Forum Allergy Rhinol 2022; 12:1435-1438. [PMID: 35595546 PMCID: PMC9790219 DOI: 10.1002/alr.23016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Daniel M. Beswick
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of CaliforniaLos AngelesCA
| | | | - Jessa E. Miller
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of CaliforniaLos AngelesCA
| | | | | | - Eszter K. Vladar
- Department of MedicineDivision of Pulmonary Sciences and Critical Care MedicineAuroraCO,Department of Cell and Developmental BiologyUniversity of Colorado School of MedicineAuroraCO
| | | | | | - Jennifer L. Taylor‐Cousar
- Department of MedicineNational Jewish HealthDenverCO,Department of PediatricsNational Jewish HealthDenverCO
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Association between Periodontitis and Chronic Rhinosinusitis Involving Maxillary Sinus Measured by Lund Mackay Staging System. Healthcare (Basel) 2022; 10:healthcare10101961. [PMID: 36292408 PMCID: PMC9602182 DOI: 10.3390/healthcare10101961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/04/2022] Open
Abstract
This study aimed to evaluate the association between periodontitis and chronic rhinosinusitis (CRS) via cone-beam-computed tomography (CBCT) using the Lund–Mackay staging system. CBCT images from different departments of the school of dentistry, at Prince Sattam University were evaluated for the presence of rhinosinusitis. All the CBCT scans were exposed for multiple indications, and no patients had a scan exposed solely for this study. The Lund–Mackay staging system was used to measure the CRS in the CBCT. Descriptive statistics for the frequencies and percentages were used to summarize the data. Logistic regression was used to examine the associations between periodontitis and CRS. Each variable was assessed individually by using multivariable analysis. Collinearity issues among the variables were solved to select a limited set of factors using a stepwise variable selection procedure. A total of 399 CBCT images were included in the current research. Logistic regression showed that only gender was significantly associated (p = 0.0001) with the presence of CRS. However, a stepwise variable selection procedure included gender and bone loss as significantly associated with CRS. No significant difference was observed between unilateral vs. bilateral CRS in gender, bone loss, medical status, and periodontitis. However, only gender showed a significant difference in both bilateral vs. no CRS and unilateral vs. no CRS. Periodontitis is not associated with CRS. However, gender has a significant influence on CRS.
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7
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Orozco FR, Lin M, Hur K. Cannabis Use and Sinonasal Symptoms in US Adults. JAMA Otolaryngol Head Neck Surg 2022; 148:854-861. [PMID: 35900733 PMCID: PMC9335247 DOI: 10.1001/jamaoto.2022.2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Cannabis is the most commonly used illicit substance in the US and worldwide. Understanding the association between cannabis use and sinonasal symptoms may help clinicians and patients better understand the symptomatology associated with cannabis use. Objective To assess the association between frequency of cannabis use and presence of sinonasal symptoms in a nationally representative sample of US adults. Design, Setting, and Participants This population-based, retrospective cross-sectional study included adults aged 20 to 69 years who had completed data on sinonasal symptoms and substance use for the 2013 to 2014 National Health and Nutrition Examination Survey. The data were analyzed in February 2022. Exposures Cannabis use frequency. Main Outcomes and Measures Presence of sinonasal symptoms, demographic information, and medical history were obtained from National Health and Nutrition Examination Survey questionnaires. Presence of any sinonasal symptoms was defined as responding yes to any of a series of questions assessing rhinologic symptoms. Regular cannabis users were defined as using cannabis 15 or more times within the last 30 days. Nonregular users were defined as using cannabis fewer than 15 times within the last 30 days. Multivariable models were used to examine the association between frequency of cannabis use and presence of sinonasal symptoms while adjusting for demographic characteristics and medical comorbidities. Results The study included 2269 adults with a mean (SD) age of 36.5 (12.4) years (1207 women [53.2%]; 330 Asian [14.5%], 739 Black [32.6%], 461 Hispanic [20.3%], and 656 White [28.9%] individuals). The prevalence of sinonasal symptoms among regular cannabis users (45.0%; 95% Cl, 38.9%-51.1%) was lower than the prevalence among never users (64.5%; 95% Cl, 58.3%-68.8%). Compared with adults who had never used cannabis, regular cannabis users were less likely to have sinonasal symptoms (odds ratio, 0.22, 95% CI, 0.10-0.50). Current tobacco smokers were more likely to have sinonasal symptoms (odds ratio, 1.96; 95% CI, 1.17-3.28). The most common sinonasal symptoms reported were nasal congestion (62.8%; 95% Cl, 60.2%-65.4%) and change in smell (17.8%; 95% Cl, 15.2%-20.9%). Conclusions and Relevance This cross-sectional study found that the prevalence of sinonasal symptoms was lower among regular cannabis users. Further research is needed to elucidate the mechanisms underlying the association between cannabis use and sinonasal symptoms.
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Affiliation(s)
| | - Matthew Lin
- Keck School of Medicine of the University of Southern California, Los Angeles
| | - Kevin Hur
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles
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Serindere G, Bilgili E, Yesil C, Ozveren N. Evaluation of maxillary sinusitis from panoramic radiographs and cone-beam computed tomographic images using a convolutional neural network. Imaging Sci Dent 2022; 52:187-195. [PMID: 35799961 PMCID: PMC9226235 DOI: 10.5624/isd.20210263] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/14/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Materials and Methods Results Conclusion
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Affiliation(s)
- Gozde Serindere
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Ersen Bilgili
- Department of Dentomaxillofacial Radiology, Izmir Education Dental Hospital, Izmir, Turkey
| | - Cagri Yesil
- Department of Computer Engineering, Faculty of Engineering, Yeditepe University, İstanbul, Turkey
| | - Neslihan Ozveren
- Department of Pediatric Dentistry, Faculty of Dentistry, Trakya University, Edirne, Turkey
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Wu AW, Borrelli M, Raskin J, Hopp ML, Mirocha J, Tang DM. Correlation of chronic rhinosinusitis-related symptoms with CT subsite. Int Forum Allergy Rhinol 2021; 12:791-794. [PMID: 34694704 DOI: 10.1002/alr.22920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/19/2021] [Accepted: 10/13/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Arthur W Wu
- Cedars-Sinai Sinus Center of Excellence, Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Michela Borrelli
- Cedars-Sinai Sinus Center of Excellence, Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Jonathan Raskin
- Cedars-Sinai Sinus Center of Excellence, Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Martin L Hopp
- Cedars-Sinai Sinus Center of Excellence, Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - James Mirocha
- Biostatistics and Bioinformatics Research Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Dennis M Tang
- Cedars-Sinai Sinus Center of Excellence, Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
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Baba Caliaperoumal VB, Gs D, Velayutham P, Krishnaswami B, Rama Krishnan KK, Savery N. Correlation of Clinical Symptoms With Nasal Endoscopy and Radiological Findings in the Diagnosis of Chronic Rhinosinusitis: A Prospective Observational Study. Cureus 2021; 13:e16575. [PMID: 34434675 PMCID: PMC8380294 DOI: 10.7759/cureus.16575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION In the diagnosis of chronic rhinosinusitis (CRS), computed tomography (CT) of the nose and paranasal sinuses (PNS) remains the gold standard investigation. Though the diagnostic nasal endoscopy (DNE) is an equally effective and easily available investigation for diagnosis of CRS, its reliability and clinical significance to that of patient's symptoms have to be proven. OBJECTIVE The purpose of this study is to determine the correlations between the symptom severity score, radiological score, and the endoscopic score in the diagnosis of CRS. Methods: This prospective observational study included 70 patients with CRS. It was conducted in a tertiary care institute from January 2019 to June 2020. All patients were subjected to DNE and CT nose and PNS. Symptom score was assessed using Visual Analogue Scale (VAS) score of 0-10. DNE and CT scores were calculated using the Lund-Kennedy endoscopic scoring system and the Lund-Mackay CT scoring system, respectively. The correlation between these scores were done using Pearson's correlation coefficient (p-value). RESULTS The mean and standard deviation of the symptom score by VAS was 7 ± 1.7; the Lund-Kennedy score was 7.6 ± 2.3, and the Lund-Mackay score was 14.3 ± 6.5, respectively. The symptom score had moderate correlation with the Lund-Kennedy Score (r = 0.643, p < 0.001) and high degree of correlation with the Lund-Mackay Score (r = 0.835, p < 0.001). The Lund-Kennedy score had a positive correlation with The Lund-Mackay score. CONCLUSION DNE can be utilized as an early diagnostic tool in the clinical evaluation of CRS and is equally effective as CT in diagnosing the same. At the same time, a CT scan can be done in patients with positive symptoms and can be reserved as a second-level investigation for those patients with negative endoscopic findings but who become symptomatic on follow-up.
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Affiliation(s)
| | - Dharanya Gs
- Ear Nose Throat, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, IND
| | - Prabu Velayutham
- Ear Nose Throat, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, IND
| | | | | | - Nishanth Savery
- Ear Nose Throat, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, IND
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Chronic rhinosinusitis in COPD: A prevalent but unrecognized comorbidity impacting health related quality of life. Respir Med 2020; 171:106092. [PMID: 32846336 DOI: 10.1016/j.rmed.2020.106092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Unified airway disease where upper respiratory tract inflammation including chronic rhinosinusitis (CRS) affects lower airway disease is known from asthma, bronchiectasis, cystic fibrosis and primary ciliary dyskinesia but little is known about CRS and health related quality of life in COPD. We investigate firstly, the prevalence of CRS in COPD. Secondly the impact of CRS on HRQoL. Thirdly, risk factors for CRS in COPD. METHODS cross-sectional study of CRS in 222 COPD patients from 2017 to 2019 according to EPOS2012/2020 and GOLD2019 criteria. Patients completed the COPD assessment test (CAT), Medical Research Council dyspnea scale and Sinonasal outcome test 22 (SNOT22) and questions on CRS symptoms. They then had a physical examination including flexible nasal endoscopy, CT-sinus scan and HRCT-thorax. RESULTS 22.5% of COPD patients had CRS and 82% of these were undiagnosed prior to the study. HRQoL (CAT, SNOT22 and the SNOT22-nasal symptom subscore) was significantly worse in COPD patients with CRS compared with those without CRS and healthy controls. Multiple logistic regression analysis suggests that the most likely candidate for having CRS was a male COPD patient who actively smoked, took inhaled steroids, had a high CAT and SNOT22_nasal symptom subscore. DISCUSSION the largest clinical study of CRS in COPD and the only study diagnosing CRS according to EPOS and GOLD. This study supports unified airway disease in COPD. The SNOT22_nasal symptoms subscore is recommended as a standard questionnaire for COPD patients and patients at risk should be referred to an otorhinolaryngologist.
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12
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Lee DJ, Yip J, Lee JM. Nasal nitric oxide as a long-term monitoring and prognostic biomarker of mucosal health in chronic rhinosinusitis. Int Forum Allergy Rhinol 2020; 10:971-977. [PMID: 32279461 DOI: 10.1002/alr.22581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Nasal nitric oxide (nNO) is a potential biomarker of chronic rhinosinusitis (CRS), and correlates well with endoscopic and radiologic severity of disease. However, the long-term profile of nNO as a biomarker is not established in the literature. The objectives of our study were to examine whether nNO can maintain this correlation in a 5-year follow-up after endoscopic sinus surgery (ESS) and to investigate whether nNO value can be used to prognosticate revision rates in patients with CRS. METHODS We enrolled CRS patients 5 years after initial ESS at our institution. Patients underwent initial ESS at our institution between January 2013 and January 2015. Patients prospectively had the following measurements at baseline, 1 month, 6 months, and 5 years post-ESS: nNO levels, Lund-Kennedy Endoscopy Score (LKES), and 22-item Sino-Nasal Outcome Test-22 (SNOT-22) score. We also compared the nNO levels between patients who underwent revision ESS and those who did not. RESULTS There were 32 patients included in the study with 8 patients undergoing revision ESS during the 5-year follow-up. nNO levels were elevated at 1 month, 6 months, and 5 years post-ESS compared to baseline. A significant negative correlation between nNO and LKES was found at 5 years post-ESS. nNO levels were significantly reduced at baseline and 6 months post-ESS in the revision cohort compared to the nonrevision cohort despite having comparable radiologic severity. CONCLUSION nNO may serve as a noninvasive long-term biomarker to monitor sinus disease severity and to prognosticate results in patients with CRS. This has implications for potential integration into clinical practice.
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Affiliation(s)
- Daniel J Lee
- Division of Rhinology, Department of Otolaryngology-Head & Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Jonathan Yip
- Division of Rhinology, Department of Otolaryngology-Head & Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - John M Lee
- Division of Rhinology, Department of Otolaryngology-Head & Neck Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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14
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Kidwai SM, Parasher AK, Agbetoba A, Iloreta AM, Som P, Govindaraj S, Miles BA. The impact of nasal airflow on sinus mucosa: A radiographic review. Am J Otolaryngol 2018; 39:507-510. [PMID: 29937103 DOI: 10.1016/j.amjoto.2018.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/13/2018] [Accepted: 05/26/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a disease of widespread prevalence and high morbidity. Many suggest that the introduction of toxins and allergens via nasal airflow plays a significant role in the development of CRS. In patients who have undergone total laryngectomy, nasal airflow is disrupted, providing an opportunity to examine the role of nasal airflow in sinonasal pathology. METHODS All patients who received a total laryngectomy between 2002 and 2012 with preoperative and postoperative computed tomography (CT) scans were retrospectively reviewed. The Lund-Mackay (LM) score for each sinus was recorded for both scans. The assessment of differences in pre-operative and post-operative LM scores was analyzed utilizing paired t-tests. RESULTS 56 patients underwent total laryngectomy and had both preoperative and postoperative CT scans. There were no significant differences in the LM scores between pre-operative and post-operative scans within each sinus (frontal sinus, p = 1.0; anterior ethmoid sinus, p = 0.77; posterior ethmoid sinus, p = 0.45; maxillary sinus, p = 0.90; sphenoid sinus, p = 0.63; ostiomeatal complex, p = 0.78) or in the total LM scores (p = 0.97). Furthermore, patients with pre-operative sinonasal mucosal thickening (total LM score > 0) showed no significant change in their total LM score post-operatively (p = 0.13). CONCLUSION In total laryngectomy patients, studies demonstrate that a disruption in nasal airflow is correlated to altered sinonasal physiology and decreased subjective symptoms. However, our study shows that the disruption of nasal airflow results in no significant change in radiographic evidence of sinonasal mucosal thickening.
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Brooks SG, Trope M, Blasetti M, Doghramji L, Parasher A, Glicksman JT, Kennedy DW, Thaler ER, Cohen NA, Palmer JN, Adappa ND. Preoperative Lund-Mackay computed tomography score is associated with preoperative symptom severity and predicts quality-of-life outcome trajectories after sinus surgery. Int Forum Allergy Rhinol 2018; 8:668-675. [PMID: 29517156 PMCID: PMC5995576 DOI: 10.1002/alr.22109] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 11/27/2017] [Accepted: 02/06/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Disagreement exists about the relationship between Lund-Mackay CT scores (LMCTS) and quality-of-life outcome (QoL) measures. We investigated whether preoperative LMCTS are associated with preoperative QoL, and whether LMCTS is predictive of postoperative QoL outcomes in chronic rhinosinusitis (CRS) patients. METHODS Adult patients with medically recalcitrant CRS (n = 665) were enrolled in a prospective, observational cohort study. Preoperative LMCTS and pre- and postoperative self-reported QoL outcomes (22-item Sino-Nasal Outcomes Test [SNOT-22]) were collected and evaluated over 12 months. Five hundred sixty-eight patients met the inclusion criteria. Longitudinal linear mixed-effects modeling was used to investigate the effect of LMCTS on QoL after functional endoscopic sinus surgery (FESS). RESULTS Preoperative LMCTS were significantly associated with preoperative SNOT-22 scores (p < 0.01) and postoperative SNOT-22 scores (p < 0.001), driven by Extranasal and Rhinologic subdomains of the QoL questionaire. Patients in the lowest preoperative LMCTS quartile had the lowest mean change in SNOT-22 scores at 12 months (16.8 points; 95% confidence interval [CI], 12.2-21.3). Patients in the second and third lowest preoperative LMCTS quartiles had mean changes at 12 months of 21.1 points (95% CI, 16.7-25.4) and 23.1 points (95% CI, 18.3-27.9). Patients in the highest preoperative LMCTS quartile had the greatest improvement in SNOT-22 scores after FESS (29.9 points; 95% CI, 24.9-34.8). The difference in QoL change at 12 months between the highest and lowest preoperative LMCTS quartiles was 13.1 points (95% CI, 6.0-20.2; p < 0.001). CONCLUSION Our study demonstrates that preoperative LMCTS correlate with preoperative extranasal and rhinologic symptom severity and that the LMCTS is an indicator of postsurgical QoL outcomes for medically recalcitrant chronic rhinosinusitis patients in a large tertiary otolaryngology setting.
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Affiliation(s)
- Steven G. Brooks
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Michal Trope
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mariel Blasetti
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Laurel Doghramji
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Arjun Parasher
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Jordan T. Glicksman
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - David W. Kennedy
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Erica R. Thaler
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Noam A. Cohen
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA
- Monell Chemical Senses Center, Philadelphia, PA
| | - James N. Palmer
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Nithin D. Adappa
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
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Kirsch CF, Bykowski J, Aulino JM, Berger KL, Choudhri AF, Conley DB, Luttrull MD, Nunez D, Shah LM, Sharma A, Shetty VS, Subramaniam RM, Symko SC, Cornelius RS. ACR Appropriateness Criteria ® Sinonasal Disease. J Am Coll Radiol 2017; 14:S550-S559. [DOI: 10.1016/j.jacr.2017.08.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 01/09/2023]
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17
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Yeo NK, Park WJ, Ryu IS, Lim HW, Song YJ. Is Facial or Head Pain Related to the Location of Lesions on Computed Tomography in Chronic Rhinosinusitis? Ann Otol Rhinol Laryngol 2017; 126:589-596. [DOI: 10.1177/0003489417717268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Nam-Kyung Yeo
- Department of Otorhinolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Woo Joo Park
- Department of Family Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - In Sun Ryu
- Department of Otorhinolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Hyun Woo Lim
- Department of Otorhinolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Yong Jin Song
- Department of Otorhinolaryngology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
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Keswani A, Dunn NM, Manzur A, Kashani S, Bossuyt X, Grammer LC, Conley DB, Tan BK, Kern RC, Schleimer RP, Peters AT. The Clinical Significance of Specific Antibody Deficiency (SAD) Severity in Chronic Rhinosinusitis (CRS). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2017; 5:1105-1111. [PMID: 28132798 PMCID: PMC5503775 DOI: 10.1016/j.jaip.2016.11.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/28/2016] [Accepted: 11/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite the increased identification of specific antibody deficiency (SAD) in chronic rhinosinusitis (CRS), little is known about the relationship between SAD severity and the severity and comorbidities of CRS. The prevalence of an impaired antibody response in the general population is also unknown. OBJECTIVE The objective of this study was to determine if the SAD severity stratification applies to real-life data of patients with CRS. METHODS An electronic health record database was used to identify patients with CRS evaluated for humoral immunodeficiency with quantitative immunoglobulins and Streptococcus pneumoniae antibody titers before and after pneumococcal vaccine. SAD severity was defined, according to the guidelines, based on the numbers of titers ≥1.3 μg/dL after vaccination: severe (≤2 serotypes), moderate (3-6 serotypes), and mild (7-10 serotypes). Comorbidities and therapeutic response were assessed. The prevalence of an impaired antibody response in a normal population was assessed. RESULTS Twenty-four percent of the patients with CRS evaluated for immunodeficiency had SAD, whereas 11% of a normal population had an impaired immune response to polysaccharide vaccination (P < .05). When evaluated by the practice parameter definition, 239 of 595 (40%) met the definition of SAD. Twenty-four (10%) had severe SAD, 120 (50%) had moderate SAD, and 95 (40%) had mild SAD. Patients with moderate-to-severe SAD had worse asthma, a greater likelihood of pneumonia, and more antibiotic courses in the 2 years after vaccination than patients with mild SAD. CONCLUSIONS This study provides real world data supporting stratification of SAD by severity, demonstrating a significant increase in the comorbid severity of asthma and infections in CRS patients with moderate-to-severe SAD compared with those with mild SAD and those without SAD.
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Affiliation(s)
- Anjeni Keswani
- Division of Allergy-Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill.
| | - Neha M Dunn
- Division of Allergy-Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Angelica Manzur
- Division of Allergy-Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Sara Kashani
- Division of Allergy-Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Xavier Bossuyt
- Department of Microbiology and Immunology, Experimental Laboratory Immunology, KU Leuven, Leuven, Belgium; Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Leslie C Grammer
- Division of Allergy-Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - David B Conley
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Bruce K Tan
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Robert P Schleimer
- Division of Allergy-Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill; Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Anju T Peters
- Division of Allergy-Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill
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Julkunen A, Terna E, Numminen J, Markkola A, Dastidar P, Karjalainen M, Huhtala H, Rautiainen M, Meurman J, Toppila-Salmi S. Inter-observer agreement of paranasal sinus computed tomography scans. Acta Otolaryngol 2017; 137:611-617. [PMID: 27981879 DOI: 10.1080/00016489.2016.1262552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONCLUSION The study demonstrated considerable inter-observer variation in certain surgically important structures. This would indicate the significance for consultation when evaluating sinus CT scans of CRS patients for planned advanced sinus surgery. OBJECTIVES After the failure of medical treatment of chronic rhinosinusitis (CRS), the need for surgery and the pre-operative planning of safe surgery is based on computed tomography (CT) findings. The aim of this prospective study was to compare inter-observer agreement of anatomical and surgical structures of sinus CT scans. The hypothesis was that the agreement between observers is good. METHODS Of these 57 CRS patients, Lund-Mackay (LM) scores and 43 other structural parameters were analyzed blinded. The reproducibility of the findings between three observers, a radiologist, an Ear, nose and throat (ENT) surgeon, and an ENT resident, were compared. RESULTS In general, there was moderate inter-observer agreement of the structures by Cohen's kappa coefficient. Poor reproducibility was observed in the following structures: optic nerve, insertion of the uncinated process, anterior ethmoidal artery, and Keros class.
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Affiliation(s)
- Anna Julkunen
- Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Emma Terna
- Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
| | - Jura Numminen
- Department of Otorhinolaryngology, University of Tampere, Tampere, Finland
- Department of Ear and Oral diseases, Tampere University Hospital, Tampere, Finland
| | - Antti Markkola
- University of Helsinki and HUS Imaging, Helsinki, Finland
| | - Prasun Dastidar
- Medical Imaging Centre, Department of Radiology, Tampere University Hospital, Finland
| | - Matti Karjalainen
- Department of Otorhinolaryngology, University of Tampere, Tampere, Finland
| | - Heini Huhtala
- School of Public Health, University of Tampere, Tampere, Finland
| | - Markus Rautiainen
- Department of Otorhinolaryngology, University of Tampere, Tampere, Finland
- Department of Ear and Oral diseases, Tampere University Hospital, Tampere, Finland
| | - Jukka Meurman
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sanna Toppila-Salmi
- Transplantation Laboratory, Haartman Institute, University of Helsinki, Helsinki, Finland
- Department of Allergy, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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20
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Falco JJ, Thomas AJ, Quin X, Ashby S, Mace JC, Deconde AS, Smith TL, Alt JA. Lack of correlation between patient reported location and severity of facial pain and radiographic burden of disease in chronic rhinosinusitis. Int Forum Allergy Rhinol 2016; 6:1173-1181. [DOI: 10.1002/alr.21797] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/24/2016] [Accepted: 04/18/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Jeffrey J. Falco
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Utah; Salt Lake City UT
| | - Andrew J. Thomas
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Utah; Salt Lake City UT
| | - Xuan Quin
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Utah; Salt Lake City UT
| | - Shaelene Ashby
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Utah; Salt Lake City UT
| | - Jess C. Mace
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology; Oregon Health and Science University; Portland OR
| | - Adam S. Deconde
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery; University of California, San Diego; San Diego CA
| | - Timothy L. Smith
- Department of Otolaryngology-Head and Neck Surgery, Division of Rhinology; Oregon Health and Science University; Portland OR
| | - Jeremiah A. Alt
- Sinus and Skull Base Surgery Program, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Utah; Salt Lake City UT
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21
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Sheikh SI, Handly B, Ryan-Wenger NA, Hayes D, Kirkby SE, McCoy KS, Lind M. Novel Computed Tomography Scoring System for Sinus Disease in Adults With Cystic Fibrosis. Ann Otol Rhinol Laryngol 2016; 125:838-43. [PMID: 27357973 DOI: 10.1177/0003489416656645] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is no easy to use scoring system for computed tomography (CT) scans of the sinuses that is specific to cystic fibrosis (CF). We propose a simple and easily implemented scoring system to quantify severity of sinus disease in adults with CF. STUDY DESIGN Case series with chart review. SETTING Academic tertiary-care referral center. SUBJECTS Sixty-nine adult patients with CF and 50 age-matched controls. METHODS We validated a scoring system for CF sinus disease. The CT scans were interpreted by 3 physicians on 2 separate sittings. Parameters include maxillary opacification, nasal obstruction, lateral nasal wall displacement, uncinate process absence/demineralization, and presence/absence of mucocele. RESULTS Patients with CF aged 21 to 30 years (mean = 24.7 ± 2.49). In CF cohort (n = 69), intrarater reliability for the 10 CT categories ranged from .70 to 1.00. Twenty-six (87%) were in the excellent range, and the remaining 4 (13%) were evaluated as good. In the non-CF cohort (n = 50), reliabilities ranged from .44 to 1.00. Twenty-seven (90%) were in the excellent range. For interrater reliability, in the CF cohort, 10 CT categories across the 3 raters ranged from .55 to 1.00. Excellent reliability was achieved in 15 (50%) of the observations. In the non-CF cohort, reliabilities ranged from .44 to 1.00. CONCLUSION A novel and easy to use CT scoring system for CF sinus disease in adults was validated with inter- and intrarater reliability. This new CF sinus disease-specific scoring system can be used by clinicians, surgeons, and radiologists.
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Affiliation(s)
- Shahid I Sheikh
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Brian Handly
- Radiology, The Ohio State University College of Medicine, Columbus, Ohio, USA Radiological Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nancy A Ryan-Wenger
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Don Hayes
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Stephen E Kirkby
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Karen S McCoy
- Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Meredith Lind
- Otolaryngology, The Ohio State University College of Medicine, Columbus, Ohio, USA Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, USA
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Kilty S, Leung R, Rudmik L. Economic evaluation of a computed tomography directed referral strategy for chronic rhinosinusitis. Clin Otolaryngol 2016; 41:782-787. [DOI: 10.1111/coa.12650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- S.J. Kilty
- Department of Otolaryngology- Head and Neck Surgery; The University of Ottawa; Ottawa ON Canada
- The Ottawa Hospital Research Institute (OHRI); Ottawa ON Canada
| | - R. Leung
- Royal Victoria Regional Health Centre; Barrie ON Canada
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto; Toronto ON Canada
| | - L. Rudmik
- Division of Otolaryngology; Department of Surgery; University of Calgary; Calgary AB Canada
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Anselmo-Lima WT, Sakano E, Tamashiro E, Nunes AAA, Fernandes AM, Pereira EA, Ortiz É, Pinna FDR, Romano FR, Padua FGDM, Mello Junior JF, Teles Junior J, Dolci JEL, Balsalobre Filho LL, Kosugi EM, Sampaio MH, Nakanishi M, Santos MCJD, Andrade NAD, Mion ODG, Piltcher OB, Fujita RR, Roithmann R, Voegels RL, Guimarães RES, Meirelles RC, Paula Santos R, Nakajima V, Valera FCP, Pignatari SSN. Rhinosinusitis: evidence and experience: October 18 and 19, 2013 - São Paulo. Braz J Otorhinolaryngol 2015; 81:S1-S49. [PMID: 25697512 PMCID: PMC10157818 DOI: 10.1016/j.bjorl.2015.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Wilma T Anselmo-Lima
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Eulália Sakano
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Edwin Tamashiro
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | | | | | - Érica Ortiz
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Fábio de Rezende Pinna
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Fabrizio Ricci Romano
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | | | - João Teles Junior
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | | | - Olavo de Godoy Mion
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | | | - Renato Roithmann
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Richard Louis Voegels
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Roberto Campos Meirelles
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | | | - Victor Nakajima
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), São Paulo, SP, Brazil
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Garneau J, Ramirez M, Armato SG, Sensakovic WF, Ford MK, Poon CS, Ginat DT, Starkey A, Baroody FM, Pinto JM. Computer-assisted staging of chronic rhinosinusitis correlates with symptoms. Int Forum Allergy Rhinol 2015; 5:637-642. [PMID: 25854318 DOI: 10.1002/alr.21499] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 11/28/2014] [Accepted: 01/01/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Lund-Mackay (LM) staging system for chronic rhinosinusitis (CRS) does not correlate with clinical parameters, likely due to its coarse scale. We developed a "Modified Lund Mackay" (MLM) system, which uses a three-dimensional (3D), computerized method to quantify the volume of mucosal inflammation in the sinuses, and sought to determine whether the MLM would correlate with symptoms and disease-specific quality of life. METHODS We obtained Total Nasal Symptom Score (TNSS) and 22-item Sino-Nasal Outcome Test (SNOT-22) data from 55 adult subjects immediately prior to sinus imaging. The volume of each sinus occupied by mucosal inflammation was measured using MATLAB algorithms created using customized, image analysis software after manual outlining of each sinus. Linear regression was used to model the relationship between the MLM and the SNOT-22 and TNSS. Correlation between the LM and MLM was tested using Spearman's rank correlation coefficient. RESULTS Adjusting for age, gender, and smoking, a higher symptom burden was associated with increased sinonasal inflammation as captured by the MLM (β = 0.453, p < 0.013). As expected due to the differences in scales, the LM and MLM scores were significantly different (p < 0.011). No association between MLM and SNOT-22 scores was found. CONCLUSION The MLM is one of the first imaging-based scoring systems that correlates with sinonasal symptoms. Further development of this custom software, including full automation and validation in larger samples, may yield a biomarker with great utility for both treatment of patients and outcomes assessment in clinical trials.
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Affiliation(s)
| | | | | | | | - Megan K Ford
- Department of Radiology, The University of Chicago
| | - Colin S Poon
- Department of Radiology, The University of Chicago
| | | | - Adam Starkey
- Department of Radiology, The University of Chicago
| | - Fuad M Baroody
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago
| | - Jayant M Pinto
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, The University of Chicago
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25
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Cornelius RS, Martin J, Wippold FJ, Aiken AH, Angtuaco EJ, Berger KL, Brown DC, Davis PC, McConnell CT, Mechtler LL, Nussenbaum B, Roth CJ, Seidenwurm DJ. ACR Appropriateness Criteria Sinonasal Disease. J Am Coll Radiol 2013; 10:241-6. [DOI: 10.1016/j.jacr.2013.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
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Zeng M, Long XB, Cui YH, Liu Z. Comparison of efficacy of mometasone furoate versus clarithromycin in the treatment of chronic rhinosinusitis without nasal polyps in Chinese adults. Am J Rhinol Allergy 2012; 25:e203-7. [PMID: 22185725 DOI: 10.2500/ajra.2011.25.3728] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although both nasal steroids and macrolide antibiotics have been recommended for the treatment of chronic rhinosinusitis without nasal polyps (CRSsNPs), whether there is any difference in their clinical efficacy remains unexplored. In addition, few studies have investigated their clinical efficacy in a Chinese population living in China, who present distinct inflammatory patterns compared with white patients in western countries. This study compares the efficacy of mometasone furoate and clarithromycin treatment in CRSsNP in Chinese adults in a preliminary prospective, open-label, randomized trial. METHODS Forty-three CRSsNP patients were randomized to receive mometasone furoate nasal spray at 200 μg (n = 21) or clarithromycin tablet at 250 mg (n = 22) once daily for 12 weeks. Patients were assessed before the treatment and after 4, 8, and 12 weeks after treatment. Subjective symptoms were scored on a visual analog scale. Endoscopy physical findings were scored according to Lanza-Kennedy scoring system. Moreover, smoking and atopic status and coexistence of allergic rhinitis (AR) and asthma were recorded. RESULTS Before the treatment, no significant difference in symptoms and nasal endoscopic physical findings were found between mometasone furoate and clarithromycin group. As early as 4 weeks after dosing, a significant reduction of total symptom scores, nasal obstruction, headache, rhinorrhea and overall burden scores, and mucosal swelling and nasal discharge scores were observed in both groups. No significant difference in symptom or endoscopic scores was observed between these two groups at any posttreatment observation time point. The coexistence of AR was correlated with lower scores of mucosal edema and nasal secretion in the mometasone furoate group after 12-week treatment. CONCLUSION Mometasone furoate and clarithromycin show a comparable clinical effect for CRSsNPs in Chinese adults. Mometasone furoate is more effective in improving edema and secretion for CRSsNP patients with concomitant AR.
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Affiliation(s)
- Ming Zeng
- Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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Sedaghat AR, Bhattacharyya N. Chronic rhinosinusitis symptoms and computed tomography staging: improved correlation by incorporating radiographic density. Int Forum Allergy Rhinol 2012; 2:386-91. [PMID: 22550029 DOI: 10.1002/alr.21042] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 01/23/2012] [Accepted: 02/21/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Traditional methods for staging of chronic rhinosinusitis (CRS) by computed tomography (CT) have not proven to be predictive of subjective reports of patients' symptoms. An objective measure of CRS severity that correlates well with patients' symptoms, particularly if available from CT data, would be a valuable tool in assessment of disease status and outcomes after surgery. METHODS Retrospective chart review of CRS patients with symptom data from the Rhinosinusitis Symptom Inventory (RSI) and objective data from a sinus CT scan. CRS disease severity on CT imaging was measured according to the traditional Lund-Mackay scoring, as well as by raw measures of the densities of sinus opacities (in Hounsfield units [HU]) and density-weighted Lund-Mackay scoring. These data were related to symptom severity scores using a multivariate regression model. RESULTS There was no significant correlation between either raw density values of sinus opacities or weighted Lund-Mackay scores with facial or total symptom scores. Oropharyngeal symptoms scores were negatively correlated with the sum of "average HU" values (p = 0.036, β = -1.120) but were positively correlated with the sum of "maximum HU" values (p = 0.047, β = 1.221). There was a significant negative correlation between the systemic symptoms score and mean of "average HU" values (p = 0.010, β = -0.272). Finally, there was a positive correlation between "maximum HU" value-weighted Lund-Mackay score with nasal symptom scores (p = 0.016, β = 0.241), systemic symptom scores (p = 0.008, β = 0.605), and total symptom scores (p = 0.078, β = 0.179). CONCLUSION Incorporation of radiographic characteristics of sinus opacification with Lund-Mackay scores offers greater predictive power of patients' subjective symptom severity.
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Affiliation(s)
- Ahmad R Sedaghat
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Murthy P, Banerjee S. Predictive factors for a good outcome following endoscopic sinus surgery. Indian J Otolaryngol Head Neck Surg 2012; 65:276-82. [PMID: 24427661 DOI: 10.1007/s12070-011-0432-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Accepted: 12/20/2011] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to establish if there are any symptoms which can predict increased patient satisfaction following Endoscopic Sinus Surgery (ESS) and whether these symptoms correlate with Lund-Mackay score on Computerised Tomography (CT). A prospective observational study was performed. Ninety-three consecutive patients who were offered ESS were recruited from an otolaryngology department in a UK Teaching Hospital. All patients had failed medical therapies for chronic rhinosinusitis (CRS), recurrent acute sinusitis and/or nasal polyposis. Patients were asked to complete a questionnaire pre-operatively and 12 months after surgery. Symptoms were assessed using a visual analogue scale. Endoscopic examination of the nose was performed pre and post-operatively. Lund-Mackay score was recorded for the pre-operative CT scan. Results were analysed using linear regression analysis and Pearson correlation coefficient. All symptoms improved after ESS (P < 0.001). However, a high pre-operative score for nasal discharge and olfactory disturbance were predictive of lesser improvement in symptom scoring (P < 0.001). Patients undergoing polypectomy with ESS demonstrated greater improvement in symptom score than those undergoing ESS with septoplasty or turbinate reduction surgery. There was no correlation between symptom score improvement and pre-operative Lund-Mackay score (r = 0.09). Patients who have high pre-operative symptom scores for nasal discharge and olfactory disturbance may gain less benefit from ESS, whilst those with nasal polyposis appear to perceive the greatest benefit. Increasing pre-operative Lund-Mackay score is not a predictor of a favourable operative outcome.
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Affiliation(s)
- P Murthy
- Department of Otolaryngology and Head and Neck Surgeon, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester, M8 6HD UK
| | - Sudipta Banerjee
- Department of Otolaryngology, Royal Oldham Hospital, Rochdale Road, Oldham, OL1 2JH UK
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Mainz JG, Schiller I, Ritschel C, Mentzel HJ, Riethmüller J, Koitschev A, Schneider G, Beck JF, Wiedemann B. Sinonasal inhalation of dornase alfa in CF: A double-blind placebo-controlled cross-over pilot trial. Auris Nasus Larynx 2011; 38:220-7. [DOI: 10.1016/j.anl.2010.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 09/21/2010] [Accepted: 09/21/2010] [Indexed: 10/18/2022]
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Tan BK, Chandra RK, Conley DB, Tudor RS, Kern RC. A randomized trial examining the effect of pretreatment point-of-care computed tomography imaging on the management of patients with chronic rhinosinusitis symptoms. Int Forum Allergy Rhinol 2011; 1:229-34. [DOI: 10.1002/alr.20044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 11/30/2010] [Accepted: 12/07/2010] [Indexed: 11/07/2022]
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Hirshoren N, Hirschenbein A, Eliashar R. Risk stratification of severe acute rhinosinusitis unresponsive to oral antibiotics. Acta Otolaryngol 2010; 130:1065-9. [PMID: 20233013 DOI: 10.3109/00016481003645727] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS C-reactive protein (CRP) levels may predict the extent of acute rhinosinusitis disease in the computed tomography (CT) scans, as well as the specific symptom severity. High levels may direct the physician to change the treatment. OBJECTIVE To establish tools to define 'high risk' patients suffering from acute rhinosinusitis. METHODS Patients suffering from severe unresponsive acute rhinosinusitis filled in health-related quality of life questionnaires and rated their symptoms. Blood tests and CT scans were performed. We examined the value of imaging and inflammatory markers, especially CRP, as predictors of disease severity, defined by subjective and objective means; need for surgery; and occurrence of ocular complications. RESULTS Thirty-two patients were prospectively recruited. A significant association was found between CRP levels, imaging scores, and symptoms severity. Neither ocular complications nor the need for surgery were present in the group with low CRP level.
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Affiliation(s)
- Nir Hirshoren
- Department of Otolaryngology/Head & Neck Surgery, Hadassah Ein-Kerem University Hospital, Jerusalem, 91120 Israel.
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Abstract
BACKGROUND Acute sinusitis is frequently diagnosed in young children, yet little is known regarding pediatrician practices surrounding its diagnosis and management. OBJECTIVES The purpose of this work was to describe how pediatricians diagnose and manage nonsevere acute sinusitis in otherwise healthy children < or =6 years of age. METHODS We used a mail survey administered from June to August 2007 to a national random sample of 750 general pediatricians from the American Medical Association Master File. RESULTS. The response rate was 45% (N = 271). Pediatricians reported first considering acute sinusitis at the ages of 0 to 5 (6%), 6 to 11 (17%), 12 to 23 (36%), 24 to 35 (21%), and > or =36 (20%) months. Symptoms thought to be "very important" in the diagnosis of acute sinusitis included prolonged symptom duration (93%), purulent rhinorrhea (55%), and nasal congestion (43%); 60% reported that symptom duration is more important than symptom combination. Symptom durations expected before considering the diagnosis were 1 to 6 (3%), 7 to 9 (17%), 10 to 13 (37%), 14 to 16 (38%), and > or =17 (6%) days. Fifty-eight percent reported using sinus computed tomography scans "occasionally" or more often in the diagnosis of acute sinusitis. Ninety-six percent reported treating acute sinusitis with an antibiotic "frequently" or "always." Fifty-three percent reported using contingency antibiotic prescriptions "occasionally" or more often for acute sinusitis. Adjuvants used "frequently" or "always" included saline washes (44%), systemic decongestants (28%), nasal corticosteroids (20%), and systemic antihistamines (13%). CONCLUSIONS We found significant variation in the age at which pediatricians begin considering the diagnosis of nonsevere acute sinusitis in children. Most pediatricians consider symptom duration the most important diagnostic factor. The majority of pediatricians use sinus computed tomography imaging at least occasionally in young children with nonsevere symptoms despite its limitations in this clinical setting. Although poorly understood, the use of contingency antibiotic prescriptions is common. Lastly, the use of systemic decongestants and antihistamines in young children is reported, a practice that needs to be reexamined in light of recent Food and Drug Administration warnings regarding their safety.
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Affiliation(s)
- Lon McQuillan
- Departments of Pediatrics, University of Colorado Denver, Aurora, Colorado, USA.
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van Spronsen E, Ingels KJAO, Jansen AH, Graamans K, Fokkens WJ. Evidence-based recommendations regarding the differential diagnosis and assessment of nasal congestion: using the new GRADE system. Allergy 2008; 63:820-33. [PMID: 18588547 DOI: 10.1111/j.1398-9995.2008.01729.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nasal congestion is an important symptom in nasal pathology and can be defined as an objective restriction of nasal cavity airflow because of mucosal pathology and/or increased mucus secretion (excluding anatomical variants). Using the new Grading Recommendations Assessment, Development and Evaluation system, evidence-based recommendations are made that will encompass different clinical questions regarding diagnostic modalities of nasal congestion: (i) their usefulness in assessment of presence and severity of congestion; (ii) their usefulness in assessment of etiological pathology responsible for congestion; and (iii) their usefulness in follow up and treatment effectiveness evaluation of nasal congestion.
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Affiliation(s)
- E van Spronsen
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, the Netherlands
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Hopkins C, Browne JP, Slack R, Lund V, Brown P. The Lund-Mackay staging system for chronic rhinosinusitis: how is it used and what does it predict? Otolaryngol Head Neck Surg 2007; 137:555-61. [PMID: 17903570 DOI: 10.1016/j.otohns.2007.02.004] [Citation(s) in RCA: 307] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 02/05/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The Lund-Mackay score is widely used in assessment of chronic rhinosinusitis. We aimed to describe its relationship to other measures of pre- and post-treatment health status. STUDY DESIGN Multicenter prospective study of 1840 patients undergoing surgery for chronic rhinosinusitis in the UK. RESULTS There was no absolute threshold for surgery, but patients with higher Lund-Mackay scores underwent more extensive surgery. There was no correlation between Lund-Mackay and SNOT-22 scores. The Lund-Mackay increased with increasing grade of polyposis. The Lund-Mackay score was associated with symptom reduction (coefficient = 0.24, P = 0.02) complication rates (odds ratio, 1.08, 95%CI 1.06 to 1.1), and revision rates (odds ratio, 1.03, 95% CI 1.001 to 1.06). CONCLUSIONS The Lund-Mackay score measures a different aspect of disease to "subjective" symptom scores. However, it correlates well with other markers of disease severity, the nature of surgery offered, and its outcome. SIGNIFICANCE This demonstrates the strengths and limitations of a commonly used staging system.
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Affiliation(s)
- Claire Hopkins
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London.
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Impact of Perioperative Systemic Steroids on Surgical Outcomes in Patients With Chronic Rhinosinusitis With Polyposis: Evaluation With the Novel Perioperative Sinus Endoscopy (POSE) Scoring System. Laryngoscope 2007; 117:1-28. [DOI: 10.1097/mlg.0b013e31814842f8] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Catalano PJ, Dolan R, Romanow J, Payne SC, Silverman M. Correlation of bone SPECT scintigraphy with histopathology of the ethmoid bulla: preliminary investigation. Ann Otol Rhinol Laryngol 2007; 116:647-52. [PMID: 17926585 DOI: 10.1177/000348940711600904] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Reports in the rhinology literature suggest that osteitis of the ethmoid bone may be responsible for refractory and/or recurrent sinusitis. If so, bone scanning technologies capable of detecting osteitis may be useful in diagnosing this condition and its response to treatment. The objective of this prospective cohort study was to determine the correlation of single photon emission computed tomography (SPECT) bone scintigraphy with the histopathology of the ethmoid bulla. METHODS Thirty-six patients with a diagnosis of chronic sinusitis who were scheduled to undergo sinus surgery underwent a presurgical SPECT bone scan using technetium 99m-methylene diphosphonate. All bone scans were done within 5 days of surgery. During the procedure, bone samples from the face of the ethmoid bulla were obtained and examined by a pathologist blinded to the bone scan result. In this study, histopathology consistent with osteitis was defined as a change from lamellar to woven bone. A positive bone scan was defined by the presence of increased radiotracer uptake in the ethmoid sinuses. RESULTS Thirty-two of the 36 patients had a positive bone scan on SPECT imaging, and 31 specimens demonstrated histopathologic bone changes consistent with osteitis, for a sensitivity of 93.9%. An additional 4 patients had a negative bone scan on SPECT imaging, and osteitis was identified in 2 of the 4. The specificity was 66.7%, and the positive predictive value was 96.9%. CONCLUSIONS We found that SPECT bone scanning with technetium 99m-methylene diphosphonate is a highly sensitive test for identifying osteitis in patients with chronic rhinosinusitis. It may be a useful tool in the armamentarium of the otolaryngologist to better define this disease process.
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Affiliation(s)
- Peter J Catalano
- Department of Otolaryngology-Head and Neck Surgery, Lahey Clinic, Burlington, MA 01805, USA
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Abstract
PURPOSE OF REVIEW Patients with advanced head and neck cancer are being treated with chemo-radiotherapy, and life is being prolonged, with or without persistent disease, for longer than was previously. Hypercalcaemia may present in patients with advanced or disseminated head and neck cancer, and, as such, these patients may present to a larger variety of clinicians for advice concerning their symptoms and illness. Modes of presentation of hypercalcaemia and treatment strategies are reviewed. RECENT FINDINGS There were previously few large series of head and neck cancer patients diagnosed with hypercalcaemia, which may or may not have been related to their cancer being treated. Investigations, by way of blood/serum calcium level, may identify such patients. Patients with cancer-related hypercalcaemia have a poor prognosis, but many may respond temporarily to treatment when offered, with an improvement of their quality of life and death. SUMMARY Hypercalcaemia should and must be considered in all patients who have or possibly have a diagnosis of a head and neck cancer and who present unwell with symptoms of fatigue, lethargy and somnolence. Investigation must include serum calcium (corrected for serum albumin binding) and parathyroid hormone level. Patients may be treated by a combination of rehydration and bisulphonate therapy until the serum calcium is reduced to a level below 3 mmol/l. The majority of patients diagnosed with hypercalcaemia due to head and neck malignancy die of their diseases in the short term, but some may enjoy a prolongation of life with reasonable quality if diagnosed and treated aggressively.
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Affiliation(s)
- Patrick J Bradley
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Nottingham, UK.
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